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García-Escobar A, Vera-Vera S, Jurado-Román A, Jiménez-Valero S, Galeote G, Moreno R. Subtle QRS changes are associated with reduced ejection fraction, diastolic dysfunction, and heart failure development and therapy responsiveness: Applications for artificial intelligence to ECG. Ann Noninvasive Electrocardiol 2022; 27:e12998. [PMID: 35904538 DOI: 10.1111/anec.12998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/28/2022] [Accepted: 07/03/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since the last century, the electrocardiogram (ECG) remains the non-invasive test, that is, most easily accessible, feasible, and inexpensive for cardiology assessment. In past years, many novel ECG indexes and patterns have been published that allow for a more advanced evaluation of what is currently being done, especially based on subtle QRS changes and patterns. OBJECTIVE The objective of the study was to provide an update on the evidence and clinical applications of these ECG subtle QRS changes and patterns associated with heart disease. METHODS Through the literature review, we will highlight the subtle QRS changes and patterns associated with heart disease, mainly focusing on QRS duration, voltage, morphology, axis, and QT interval. RESULTS Small increases in QRS duration are associated with a reduction in left ventricular ejection fraction (EF), increased cardiac chamber dimensions, and risk for incident heart failure (HF). Moreover, fragmentation of the QRS complex is associated with myocardial fibrosis and is a substrate for developing arrhythmic events. Besides, low amplitude QRS voltage is associated with congestive HF, and an increase in the voltage of the QRS complexes is associated with the effectiveness of diuresis treatment. Furthermore, small increases in QT interval are associated with diastolic dysfunction due to impaired sarcoplasmic reticulum calcium handling as occurs in myocardial ischemia, hypertension, or diabetes. On the other hand, in patients with left ventricular dysfunction, the QRS area is associated with clinical and echocardiographic response to cardiac resynchronization therapy regardless of the type of bundle branch block. In addition, subtle ECG changes and patterns in the left bundle branch block are associated with concomitant right ventricular dilation, mostly based on the QRS axis and voltage. Notwithstanding, to identify these subtle changes in QRS require exact manual measurements that can take time. In this regard, applying artificial intelligence (AI) to the ECG can make a quicker and more complete assessment, as well as provide a low cost when applied to large populations. CONCLUSION We provided an update on the evidence and clinical applications of these subtle QRS changes and patterns associated with diastolic dysfunction, reduced EF, and HF development and therapy responsiveness, as well as their applications for AI to ECG.
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Affiliation(s)
- Artemio García-Escobar
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain.,Institute for Health Research La Paz University Hospital (IdiPAZ), Madrid, Spain.,Biomedical Research Network Center on Cardiovascular Disease, Institute of Health Carlos III, Madrid, Spain
| | - Silvio Vera-Vera
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain.,Institute for Health Research La Paz University Hospital (IdiPAZ), Madrid, Spain.,Biomedical Research Network Center on Cardiovascular Disease, Institute of Health Carlos III, Madrid, Spain
| | - Alfonso Jurado-Román
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain.,Institute for Health Research La Paz University Hospital (IdiPAZ), Madrid, Spain.,Biomedical Research Network Center on Cardiovascular Disease, Institute of Health Carlos III, Madrid, Spain
| | - Santiago Jiménez-Valero
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain.,Institute for Health Research La Paz University Hospital (IdiPAZ), Madrid, Spain.,Biomedical Research Network Center on Cardiovascular Disease, Institute of Health Carlos III, Madrid, Spain
| | - Guillermo Galeote
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain.,Institute for Health Research La Paz University Hospital (IdiPAZ), Madrid, Spain.,Biomedical Research Network Center on Cardiovascular Disease, Institute of Health Carlos III, Madrid, Spain
| | - Raúl Moreno
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain.,Institute for Health Research La Paz University Hospital (IdiPAZ), Madrid, Spain.,Biomedical Research Network Center on Cardiovascular Disease, Institute of Health Carlos III, Madrid, Spain
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Baisan RA, Turcu CA, Condurachi EI, Vulpe V. Retrospective evaluation of notched and fragmented QRS complex in dogs with naturally occurring myxomatous mitral valve disease. Vet Q 2021; 41:301-307. [PMID: 34643161 PMCID: PMC8547883 DOI: 10.1080/01652176.2021.1992803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Myxomatous mitral valve disease (MMVD) is the most common cardiac disease in dogs. The association of QRS notching (nQRS) or fragmentation (fQRS) with disease severity is currently unknown. The study objective was to assess the prevalence of nQRS and fQRS in dogs with MMVD and its severity according to ACVIM classification and to compare the results with a group of healthy dogs. This retrospective cross-sectional study included 34 healthy control dogs and 155 dogs with spontaneous MMVD (42% of dogs in class B1, 23% in class B2 and 35% in class C). fQRS was defined as nQRS complexes in two contiguous leads in the frontal plane (leads I and aVL) and (II, III or aVF). A one-way ANOVA with Bonferroni post-hoc test was used to assess the differences in continuous data between control and MMVD groups. Of the MMVD group, 58% showed nQRS in at least one lead and 27% presented fQRS. There was no difference between the number of leads with a nQRS and disease severity (p = 0.75) nor did the number of leads with a nQRS correlate with left atrial size (r = 0.48; p = 0.5). The number of dogs with fQRS did not differ among classes of MMVD (p = 0.21). nQRS and fQRS were more prevalent in dogs with MMVD compared to control dogs (p < 0.01). This study did not identify any relationship between the number of leads with a nQRS and disease severity. However, dogs with MMVD had a higher prevalence of nQRS and fQRS compared to control group.
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Affiliation(s)
- Radu Andrei Baisan
- Clinics Department, Faculty of Veterinary Medicine, University of Applied Life Sciences "Ion Ionescu de la Brad", Iași, Romania
| | - Cătălina Andreea Turcu
- Clinics Department, Faculty of Veterinary Medicine, University of Applied Life Sciences "Ion Ionescu de la Brad", Iași, Romania
| | - Eusebiu Ionuț Condurachi
- Clinics Department, Faculty of Veterinary Medicine, University of Applied Life Sciences "Ion Ionescu de la Brad", Iași, Romania
| | - Vasile Vulpe
- Clinics Department, Faculty of Veterinary Medicine, University of Applied Life Sciences "Ion Ionescu de la Brad", Iași, Romania
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Yooprasert P, Vathesatogkit P, Thirawuth V, Prasertkulchai W, Tangcharoen T. Fragmented QRS in prediction of ischemic heart disease diagnosed by stress cardiovascular magnetic resonance imaging. Ann Noninvasive Electrocardiol 2020; 25:e12761. [PMID: 32320122 PMCID: PMC7507069 DOI: 10.1111/anec.12761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/15/2020] [Accepted: 03/22/2020] [Indexed: 11/28/2022] Open
Abstract
Background In patients with ischemic heart disease (IHD), many studies demonstrated an association between fragmented QRS complex (fQRS) on 12‐lead ECG and myocardial scar, heart failure, and increased mortality. However, data in adults without history of IHD is limited. We aimed to evaluate whether there is an association between fQRS and IHD diagnosed by stress cardiac MRI. Method We retrospectively reviewed demographic data, 12‐lead ECG, and stress cardiac MRI data from 604 patients. Fragmented QRS was defined as the presence of additional R wave (R’), notching in the nadir of R or S wave, or the presence of more than one R’ in any ECG leads. Both cardiac MRI and ECG were analyzed by two independent observers. Result Final analysis included 554 patients, 39% were male, with a mean age of 67.8 ± 11.1 years. There was positive stress cardiac MRI in 219 patients (39.5%). Older age, diabetes mellitus, and hypertension were more frequent in the positive group (p < .05). fQRS was identified in 300 patients (54.2%). Baseline characteristic did not differ significantly between patients with and without fQRS. There is an association between fQRS and IHD, OR 1.605 (95% CI 1.14–2.27), p = .007. After adjustment for age, diabetes, hypertension, renal function, and left ventricular ejection fraction, the strong association between fQRS and IHD persisted, OR 1.71 (95% CI 1.18–2.47), p = .004. Conclusion In patients without known history of coronary artery disease, fragmented QRS is independently associated with ischemic heart disease diagnosed by stress cardiac MRI.
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Affiliation(s)
- Pimpimol Yooprasert
- Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
| | - Prin Vathesatogkit
- Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
| | | | | | - Tarinee Tangcharoen
- Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
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